University of Pennsylvania

News yesterday (5/27) from the pharmaceutical industry that may prove the insidious power of promotional materials, and how little it may take to taint what is supposed to be impartial, objective decision-making. But what’s really interesting in this news, and less ambiguous, is evidence of the power of organizational policies to set ethical norms.

The news is of research about how promotional items, like pens and note pads, that bear the logo of a drug, affect the attitudes of medical students toward that drug. You’ve probably seen these pens and pads, and the like, all over your doctor’s office. The ones in the study promoted the anti-cholesterol drug Lipitor. The study appears in the Archives of Internal Medicine.

Reportedly, the study found that the little trinkets worked! According to the New York Times:

The researchers worked with 352 third- and fourth-year students at Penn, which bans most gifts, samples and meals from drug companies, and the University of Miami, which allows them.

Using a series of psychological tests, the researchers assessed whether the students had positive or negative associations with the cholesterol drug Lipitor and a competitor, Zocor, which is available generically for less money.

Most students from both schools viewed Lipitor more favorably, the researchers said.

But when the researchers sought to influence the students unconsciously by having them use promotional materials like Lipitor clipboards and notebooks, they found that the fourth-year students at Miami showed stronger positive feelings for the drug.

The results weren’t due to an Ivy League bias, said study lead author and Penn doctor David Grande.

The environment is important, he said. Grande and his coauthors, including a University of Miami business professor, speculated that Penn’s restrictions on marketing seem to have primed students there to react negatively to even a small marketing message.

(Some quick background: The PhRMA Code first took effect in 2002, amid concerns over “kick-backs” in the drug business, where drug companies allegedly rewarded doctors who wrote lots of prescriptions for their medicines by showering them with monetary favors. Clearly, you wouldn’t want the pharmas to outright bribe docs to write scrips: first, it would mean we are all underwriting those bribes as they become built in to the cost of drugs, especially because the government is such a big buyer; and second, you’d hope your doctor prescribed a particular medicine solely because it was the best thing for you. Extending this idea, various laws, regulations, government “guidances” and codes have made verboten favors from pharmaceutical (and medical device) companies to doctors — like lavish meals, golf junkets, and lucrative “consulting” contracts that do not involve any real work.)

As of January 2009, for companies that adhere to the voluntary PhRMA Code, even the formerly ubiquitous post-it notes and pens bearing a drug’s logo are now disallowed. PhRMA says the revised Code:

Prohibits distribution of non-educational items (such as pens, mugs and other “reminder” objects typically adorned with a company or product logo) to healthcare providers and their staff. The Code acknowledges that such items, even though of minimal value, “may foster misperceptions that company interactions with healthcare professionals are not based on informing them about medical and scientific issues.”

Pharma compliance leaders complained bitterly off the record about this level of restriction, but the research announced yesterday provides some vindication for this aspect of the new PhRMA Code.

On the other hand, it may simply show that advertising works.

So to me, the more interesting news in this research is the different reaction of students in the two schools studied (all the more interesting to me because I went to the law schools of both of these universities!). At U of M, where the trinkets favorably disposed the med students to Lipitor, there was no school policy about students receiving promotional items from drug companies. But at Penn, there is a policy banning promotional items — and it was at Penn that the give-aways wound up making med students feel less favorable towards Lipitor.

This is one of the neatest pieces of evidence I have seen to prove that an institution’s policies don’t just establish “the law of the land,” something that could be the basis for employee discipline. The policies do more: they establish an ethical norm, they help create the culture of the institution.